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NPI Code Detail

MEDICARE: MISS MIREILLE TAIME MSW LCSW

MEDICARE: MISS MIREILLE TAIME MSW LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker15686FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003399676
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS MIREILLE TAIME MSW LCSW
Provider Business Mailing Address
First Line : 4112 12TH ST W
Second Line :
City : LEHIGH ACRES
State : FL
Zip : 33971-5021
Country : US
Telephone Number : 239-839-9399
Fax Number :
Provider Business Practice Location Address
First Line : 390 PONDELLA RD STE 9
Second Line :
City : NORTH FORT MYERS
State : FL
Zip : 33903-4340
Country : US
Telephone Number : 239-652-0260
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2018
Last Update Date : 09/10/2018

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